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MY  EYE  SURGERIES

Graves' eye disease left me with moderate proptosis (protrusion), significant upper eyelid retraction, mild lower lid retraction, and fatty deposits in the skin around my eyes that made me look old,  tired, and freaky.   My eyes were always dry, painful, bloodshot, and sensitive to light--although I used ointment at night to keep them from drying out, since they didn't close entirely while I slept.  I had frequent broken blood vessels in the eyes, and exposure keratitis, which is an inflammation of the cornea.  My vision was less sharp than I'd ever known it, even when corrected with the best prescription.

I'd had plugs inserted in the puncta, which are tiny holes on the inner edge of the eyelid through which excess tears drain.  (This can help a little with problems associated with dryness.)  I was still uncomfortable.  I felt like a freak, and since I didn't even like looking at myself in the mirror or in photos, I wore sunglasses whenever possible.

     In early March of 1998, my first surgery was performed at Jules Stein Eye Institute (UCLA) in Los Angeles. My surgeon thought I was a borderline case for needing orbital decompression, but decided to recommend against it because of the risks.  He lowered my retracted upper lids.  Orbital "Medpor" implants were screwed to the cheekbones below my eyes to support the lower lids and increase their coverage of the eyeballs.  At the same time he removed the excess fatty deposits under the skin, which most insurance (including mine) doesn't cover--even though it's caused by the disease.

The surgery took about 4 hours under "twilight" anesthesia (monitored sedation), and my doctor told me later that I was awake during part of the surgery (when my upper lids were adjusted to the proper height), but I remember nothing.  When I first woke I couldn't open my upper lids at all, but that changed in the next few hours.  As most surgeries are these days, this was an outpatient procedure. 

     There was significant pain following this surgery, mostly in the inner portions of my lower lids where the incisions had been to place the orbital implants.  The pain and swelling increased as the days passed, and severe chemosis (inflammation of the lining of the eyeball) developed.  Chemosis is very painful, similar to a corneal abrasion.  I felt like a cat had been scratching my eyeballs, and for a couple of weeks had trouble using my eyes for anything.  My entire face swelled and I looked horrible.  In the third week there was improvement, and I returned to work.  (The soreness in the tissues around my eyes following this surgery lasted about six months.)

     As the swelling, bruising, and chemosis decreased, I noticed a soreness under my right eye.  Redness and swelling in that area  increased over the next several days; so I consulted with my local ophthalmologist, who determined that I had an infection in the area of the orbital implant.  He told me that infections in artificial materials are difficult to eradicate, and he consulted with other doctors to determine which antibiotics to use.  He cut a hole below my eye to drain the infection, and placed a piece of surgical glove in the hole to keep it from closing.  

When the first antibiotic he prescribed didn't eliminate the infection in a couple of weeks, he referred me to an internal medicine doctor, who x-rayed the area to see if an infection had spread to the bone.  He changed my antibiotic prescription to Ciprofloxen, which did improve the pain and swelling significantly.  I returned to my ophthalmologist in a couple of weeks.  He insisted that the infection was clearing up; but I didn't agree with him, as the area had a rawness that didn't feel to me like something that was healing.   We argued about that, and I left knowing he hadn't heard me.  I haven't been back to that doctor.

I remained on the Cipro, but when the raw feeling and drainage persisted, I called my surgeon at UCLA, who decided I should come back for removal of the orbital implant--so I went back with that procedure scheduled.  When he examined me, however, he decided there might still be a chance it would clear up, and kept me on the Cipro to see what would happen.

Two months later the infection was still present, though very low grade.  My surgeon decided to add Rifampin to the Cirpo I was taking, since the two together had shown some success in eradicating infections in artifical devices.  The infection didn't entirely clear up, however.  The skin developed an adhesion to the implant, and the drainage hole grew larger. 

  Click on photo for large view.

In September, 1998 I had a second surgery in L.A. to remove the infected orbital implant.  This surgery was done under general anesthesia and I was kept in the hospital overnight.  There was a lot of tissue deterioration from the infection (as well as the loss of whatever was attached to the removed implant).  The surgeon decided to use techniques from a mid-facelift surgery under the skin to fill in the affected area.  He also took a strip of tissue from the roof of my mouth (a hard palate graft) to raise my lower right lid. 

This surgery was also very uncomfortable during recuperation; but the roof of my mouth was extremely sore for six months, and that was definitely the most difficult part. 

The area below my eye healed very nicely, and my face didn't look noticeably asymmetrical to anyone but me (or so people told me).   But the tissue that had been lifted to fill the area of tissue deterioration didn't stay attached; and my upper and lower lids continued to retract from the general scarring process (fibrosis) of Graves' Disease.

     A year and a half later (June 2000) I had a second surgery to lower my retracted upper lids.  The surgeon used pericardium (heart muscle) tissue from a cadaver as a spacer material to lengthen the lid muscles; and this time the procedure was successful.  It was done under monitored sedation; and though I was asleep for most of the surgery, I remember being awake for the adjustment of my lid position.  Fortunately, the meds I was on left me so relaxed that I really didn't care! 

The pain from this surgery was minimal, especially because I was put on a tapering dose of oral prednisone following the surgery, which helps considerably with pain, swelling and inflammation.  The sutures above my eyes were the dissolving kind, and very fine--so the scars were invisible very soon afterwards. 

The only problem I had after this surgery was that one suture came loose a couple of days later.  My surgeon decided to replace it without any kind of numbing shot; since he thought it would be no more painful than a shot.   He then decided to add two more sutures for good measure.   Not fun!  But I was pleased with the outcome, other than the fact that my lower lids were still too low, giving me a sleepy look with the upper lids in a better position.

     My surgeon told me at that time he was working on procedures that might work for my lower lids, and that I should check back in a year or two to see how that was coming along.  By 2002 my upper lids had relaxed and were now too low, and my lower lids were even lower.  Although I'd had the puncta cauterized so my tears wouldn't drain, my eyes were so exposed and dry that I had exposure keratitis and corneal ulceration.  The pain and discomfort were significantly interfering with my life, and were aggravated by my work environment.  In spite of the fact that another surgery was the last thing I needed (I'd had 5 surgeries on my foot since the last eye surgery), I knew I had to do something if I wanted to keep working.

     When I consulted my surgeon about these problems, he recommended an orbital decompression.  He said that when he first met me in 1998 he wouldn't have recommended it, but that techniques had advanced since then.  He told me a lateral decompression with fat removal was indicated for me.  During this procedure, bone is burred away between the orbit and the brain, instead of the orbit and sinuses.  He thought in my case the chance of causing double vision (a risk of any orbital decompression surgery) would be minimal (5% or less). 

I was thrilled to know I could have the decompression, since I'd always hated the proptosis.

The decompression was done as an inpatient procedure under general anesthesia at UCLA on October 25, 2002.  Pain levels following this surgery weren't as severe as after the orbital implants or hard palate graft.  A low tapering dose of Prednisone was given again to help the pain, swelling, and inflammation.  As with the previous lid surgery, I kept ice (frozen baby peas in baggies, actually) on the area faithfully to reduce bleeding and swelling.  I had some mild double vision at first, but it improved when I started on the Prednisone.

     As the Prednisone dose was tapered and stopped after 5 days, the swelling increased; and double vision returned and worsened. 

     Halloween was six days after the surgery, and all I needed for a costume was my ugly fake teeth!

I was unable to return to work as scheduled three weeks following the surgery because of the double vision, which had become severe--although it was improving a little each day.  Seven weeks after the surgery my vision was still double in places, especially off to the left.  My eye muscles were slow  to work together whenever I moved my eyes.  My doctor believed this had a good chance of resolving as the swelling improved.  (The double vision resolved entirely by three months after the surgery. )

This photo was taken only three weeks after the decompression.  The swelling and bruising were mostly gone, and the sutures dissolved just over two weeks after the surgery.  The sutures were made of material as fine as one of my hairs, and the incisions (which extended beyond the crease of my eyelids) were already hardly visible.  The surgery left me with numbness in my temples and into the scalp on both sides, which is still improving. 

 April 2, 2003 I had another surgery at UCLA.  My upper lids were raised several millimeters; an orbital implant was secured underneath the right eyelid to replace the infected one that had been removed in 1998; and both lower eyelids had a lateral canthal resuspension done in another attempt to raise the lower lids.  (The tendon holding the lower lid up is tightened.)   It helped a little, but the lids didn't stay as high as they were at first.  I also have had trouble with eyelashes growing toward the eyeball in the inner corner of my lower right lid, which can range from annoying to painful. 

  August, 2003: 

Drainage continues into the eyes for many months after lower lid surgery, but is improving quite a bit now after four months.  The area under my lower right eye is still very sore and the lid muscle is inflexible, pulling the right lid down.  That should improve in time.  I probably now look more like I did before Graves' than I have for many years, though not perfectly so.

Before

 Hopefully everything will remain stable and continue to heal, so that this will have been the last reconstructive surgery.